Keep patients happy when delays occur

Avoid finger-pointing

During morning surgery rush times, registrars at Indiana University Health North Hospital in Carmel began monitoring the actual time patients were arriving in a database.

"We learned that even though surgery times are staggered, and the patients are told to come in 15 minutes prior to surgery, they were actually arriving closer together," says Brian Sauders, manager of patient access services.

The earliest scheduled patients would arrive slightly before the department opened, while the later scheduled patients would arrive well before they were instructed to arrive. "Rather than having evenly staggered arrivals, it was more like a bottleneck," says Sauders. "If 10 patients were scheduled to arrive, we would actually see closer to 20."

Armed with this information, Sauders set out to base patient access staffing on actual volumes. "We have limited FTEs, so we couldn't just add more people," says Sauders. "Instead, we utilize registration team members from different areas of the hospital. If the ED isn't really busy, we'll pull somebody to come help."

Although ED registrars aren't necessarily familiar with the specifics of the surgical registration process, they keep things moving by checking in patients or keeping them continually informed.

Monitoring arrival times helps patient access to work more closely with other service lines, such as imaging, adds Sauders. If a patient was scheduled to come 15 minutes early for a 2:30 CT scan but instead arrives right at 2:30, for example, the patient might complain to imaging that he or she had to wait despite being right on time. "In that case, the imaging location can apologize to the patient, but when imaging comes back to us, we can let them know the patient was actually 15 minutes late," says Sauders. "That allows us to work better internally as a team."

Keep patients in loop

"We don't have a lot of patients waiting an extended amount of time, but if we do for some reason, we keep them in the loop," says Sauders. "It may be that we are chasing down an order for the patient." If that's the case, patient access staff members take these steps:

• They make a point of using the patient's physician's name when talking to the waiting patient, such as stating, "We spoke to Dr. Johnson."

"That helps them to understand that we are truly doing what we say we are," Sauders says, since patients feel more comfortable knowing that access staff actually spoke to their physician.

• They identify specific stumbling blocks to a frustrated patient, such as the fact that the order was mistakenly faxed to a different location.

"In that case, we tell them that we're going to find the order. But we also let them know that we cannot complete what we have to do without that order," Sauders says.

Staff members explain that not completing the registration, and consequently the service, without the order helps to meet safety standards and is in the patient's best interest. "When explained in that manner to the patient, they have a higher level of assurance that we are here to provide the best service to them," says Sauders.

• They resist the temptation to point fingers.

"One thing we do not do is start bashing the other service line," Sauders says, adding that patient access staff instead convey to patients that they work closely with their physician and the department the patient is going to.

• If a patient is adamant that his or her physician faxed something that wasn't received by registrars, they don't argue about it.

Instead, the patient is reassured that patient access staff work closely with the patient's physician, with comments such as, "They are really good about getting us those orders. Let us just check and follow up with them," says Sauders.

"We never place blame," says Sauders. "We can't put ourselves in a light that the patient is in bad hands or that anyone is incompetent. We want to assure them that they are in the right place."

The department's wait time logs indicate that 98% of patients are seen within 10 minutes, and 92% of those are seen within five minutes. "A check-in person out front is our air traffic controller," says Sauders. "We are constantly guiding our patients. We know who has the patient now and which patient needs to be next."

If a patient does complain about a wait, patient access staff call him or her at home to apologize. "People are often surprised by that," says Sauders. "They generally compliment the staff. This is a great way to get feedback, because we don't have any formal surveys for patient access."


• Brian Sauders, Manager, Patient Access Services, Indiana University Health North Hospital, Carmel. Phone: (317) 688-3032. E-mail: